4. HEALTH SERVICES

Formal and Informal Resources for Mental Health

Almost half of the population of Haiti has no access to formal healthcare services (Caribbean Country Management Unit, 2006). Only 30% of healthcare facilities are public and most of them are in urban areas. In rural areas, 70% of health services are provided by nongovernmental organizations and include mainly primary health care. A number of hospitals are run by private foundations (Caribbean Country Management Unit, 2006). Most people in Haiti value professional biomedical services; however, they are not able to access this type of care because of structural barriers such as cost, distance and location.

The health care system in Haiti can be divided into four sectors:

1.

Public institutions administrated by the Ministry of Public Health and Population (MSPP);

2.

The private nonprofit sector, comprised of NGOs and religious organizations;

3.

The mixed nonprofit sector, where staff are paid by the government but management is carried out by the private sector;

4.

The private for-profit sector, which includes physicians, dentists, nurses and other specialists working in private practice or in clinics in urban centers.

The MSPP is responsible for the health of the population, delivery of services, policy- making and management of the health budget, which makes up 7% of total public spending (PAHO/WHO 2003). The public sector comprises about 36% of health facilities. Most institutions are autonomous; there are no networks of services. The private sector is estimated to provide one-third of the medical care in Haiti. According to a PAHO/WHO report (2003), in 2001, there were about 2,500 physicians in Haiti, of whom 88% were practicing in the country’s Ouest [West] department, an area which includes Port-au-Prince.

Mental health, as defined by Western psychiatry and psychology, has not been a priority for the government. In the absence of a mental health policy, there has been no real planning of services. The mental health system has very few professionals. A 2003 PAHO/WHO report counted 10 psychiatrists and 9 psychiatric nurses working in the public sector. Moreover, these professionals mostly work in Port-au-Prince, to which Haitians must travel to receive mental health services. There are two psychiatric hospitals in Port-au-Prince, one of which was already in a dilapidated state before the 2010 earthquake. The availability of follow-up community treatments was very limited. At the country’s second largest hospital, l’Hôpital Universitaire Justinien in the city of Cap- Haïtien, psychiatric services are limited to a monthly visit by a psychiatrist from Port-au-